THE TREATMENT OF PNEUMOCOCCIC PNEUMONIA WITH SULFAPYRIDINE

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Abstract
This paper is a review of 123 cases of pneumococcic pneumonia in adults, treated with sulfapyridine at Cook County Hospital, Chicago. 18 specific types of pneumococcus are represented. The mortality rate for the entire group was 9%, and after deducting those who died within 24 hrs., the corrected mortality was 5%, bacteriemia occurring in 24% of the patients. A smaller group was treated with sulfapyridine and serum, combined, with a mortality of 22%, bacteriemia occurring in all fatal cases. Of the factors that cause failures, delay in treatment appeared the most important. Patients who were treated prior to 96 hrs. after onset practically always recovered; mortality for those treated later rose. Patients over 40 yrs. of age suffered a much greater mortality than those under 40 yrs. If more than one lobe was involved there was a 20% increase in mortality. Patients who were alcoholic on admission had a 65% mortality if bacteriemia was present, 10% mortality if non-bacteriemic. Bacteriemia is a serious prognostic finding and always adds gravity when it is present; 65% of all fatal cases were bacteriemic. Associated or pre-existing disease played a small part in the success or failure of treatment. Sulfapyridine was effective against all types of pnenumococci encountered (18 types). Nausea and vomiting were the most frequent reactions (approx. 45%); cyanosis, fever, rash, leucopenia, anemia, diarrhea, hematuria and N retention were noted in lesser frequency. It did not prevent complications nor sterilize the blood stream. It did not interfere with the forces responsible for production of immunity. It usually caused a precipitous drop in the temp., pulse, and respiration in 24-36 hrs. The signs of toxicity abated and the clinical condition of the patient improved. The physical findings remained as in an untreated pneumonia and tended to resolve in 7-10 days after onset.